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F69 OFFICE USE: APPLICATION FOR SANITATION PERMIT ..�............................ ........... lCompleteIn Triplicate} _. _ Permit No..7.................. ........•..............1 Date Issued ...! . This Permit Expires I Year From Date Issued a Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules OaRegulations: JOS ADDRESSAOC 'Y�. .. �. �. E R •............ Owner's Name �.. ... .... . . .'. Address (J�.� / µ..7_..... _ City .%% J4. ..................f ......................._... Contractor's Name ...... !'•• ... . :......License # I1.. 3 .Y P on........................ h e;.. installation will serve: Residence ['Apartment House 0 Commercial ❑Trailer Court ❑ P i Motel [] Other ..............................!............. f i Number of living units: ... ....... Number of bedrooms .........Garbage Grinder ............ Lot Size ............... Water Supply: Public System and name..........................................................................._.................................Private Character of soil too depth of 3 feet: SandE] Silt ❑ Clay ❑ Peat ❑ Sandy Loam Clay loam ❑ Hardpan ❑ Adobe Q Fill Materlal ............ If yes, type .......................... i off'; (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse slde.j i m NEW INSTALLATION; (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) , PACKAGE TREATMENT I] Si;PTIC TANK { ] Size ................................................ Liquid Depth ........................: Capacity .................... Type .................... Material............----...... No. Compartments ..:.................. Distance to nearest: Well .........Foundation ....... Prop. Line ....................� LEACHING LINE [ ] No. of Lines ........................ Length of eachline ............................. Total Lengthi 'D' Box :..'....:...,'Type"Filter Material ....................Depth Filter Material 4 Distance to nearest: Well ........................ Foundation ........................ Property Line .......................I , SEEPAGE PIT (j Depth .................... Diameter.................❑ L, Number .....:............_......... Rock Filled Yes - ' No Wafer Table Depth..........I.....................................Rock Size ................................ !I Distance to nearest: Well ................ ........................... Foundation .................... Prop.t Line ....................I REPAIR/ADDITION (Prey. Sanitation Permit 9 ........... Date ...` ....................... Septic Tank (Specify Requirements) ......... .. ........ ................ .. ..) Disposal Field (Specify Requirements) 7t...1 ti......... `Q"�................. ..... (Draw existing and required Addition on reverse side) 3 I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin" County Ordinances, State Laws, and Rules and Regulations of th'o San Joaquin Local Health, District, Homo ownor.or. licen- sed agents signature certifies the following: "I certify that in tho performanco of the work for which this permit is Issued,' I shall..not. employ any porion in such manner as to become subject to orkman's Compensation laws of California." Signed............................................ �............................ Owner . r.. � ......._.......... Title�-l!1 .F�d`t.................................. By .............. ............. . . (if otl r than owner) r APPLICATION ACCEPTED BY.. BUILDING PERMIT ISSUED ....... ADDITIONAL COMMENTS ........ e ..' ................ FOR DEPARTMENT USE ONLY I, ., DATE . �.:- .�,%.:::.�.6.. ___—� �.L.•• ...DATE ........................... ............... .... .............................................. ..................................................... ..................... ........................ •.......................................I.... ..... ..... .... ........................................:......I................................................................. ... ........ .......................... ..... ......... .:..................-.....:............_......::....................... . Final inspection by: ......... C,.=...... , .. . . ..... ............................... ............................. Date . .. r� ... :......... . -+ IJ'E[ 33 24 1-60 lieu. SNI SAN"JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3P1